Summaries of health policy coverage from major news organizations

The quality of care for people belonging to HMOs is improving, but enrollment in the plans is continuing to decrease, according to a report released Monday by the National Committee for Quality Assurance, CQ HealthBeat reports. The report looked at 289 health plans that publicly report quality data -- the large majority of which were HMOs -- representing about 20% of the U.S. health care system.

NCQA said performance last year improved in 18 of 22 clinical measures. The most notable improvements were a 4.6% increase to 66.8% in the number of people whose high blood pressure was under control and a 4.4% increase to 64.8% in the number of diabetics whose cholesterol was under control, CQ HealthBeat reports. However, the study found that discrepancies between recommended and actual use of best treatment practices lead to between 39,000 and 83,000 preventable deaths each year (CQ HealthBeat [1], 10/3)

Although the study found the quality of care from HMOs is generally improving, it also found the number of patients enrolled in HMOs decreased by 4.5 million to a total of 64.5 million in 2004. Karen Davis, president of the Commonwealth Fund, said that the study does not provide information about increasingly popular health insurance options, such as PPOs and high-deductible plans that employ health savings accounts (Snowbeck, Pittsburgh Post-Gazette, 10/4).

An NCQA release noted that PPOs and high-deductible plans, "with few exceptions, ... tend not to measure or report on their performance." Richard Sorian, NCQA's vice president for public policy, said that employers had pressured HMOs to release quality-of-care data and should do the same with other types of plans. NCQA President Margaret O'Kane said, "The new mantra for health care purchasers needs to be, 'Show us your data.' Why trust your family's health to an organization that operates behind closed doors?" (CQ HealthBeat [1], 10/3).

U.S. News and World Report Rankings

U.S. News and World Report used the NCQA study as the basis of a new magazine feature called "America's Best Health Plans." U.S. News' Oct. 10 issue ranked hundreds of insurers in three categories: commercial, Medicare and Medicaid.

U.S. News Health Editor Bernadine Healy, former director of NIH, said the rankings used care ratings in addition to enrollee satisfaction with plans' doctors and the convenience of access to care (CQ HealthBeat [2], 10/3).